4123-6-21.2
Pharmacy and therapeutics committee.

The bureau of workers' compensation pharmacy and therapeutics
(P&T) committee is hereby created to advise the administrator and the chief
medical officer with regard to issues involving medication therapy for injured
workers. A list of physician and pharmacist providers, each holding a
professional license in good standing, who have agreed to serve on the P&T
committee and who would add credibility and diversity to the mission and goals
of the committee shall be developed and maintained by the chief medical
officer. Providers may also be nominated for inclusion on the list by provider
associations and organizations including but not
limited to: deans of Ohio's allopathic and osteopathic medical schools,
deans of Ohio's colleges of pharmacy, presidents of Ohio's various allopathic
and osteopathic medical associations, the Ohio pharmacists association, the
Ohio state medical board, and the Ohio state pharmacy board.

(A)
The P&T committee shall consist of
the bureau pharmacy program director and
not
more than thirteen nor less than five voting members who shall be licensed
physicians and licensed pharmacists representing the diverse group
of providers that provide care to the injured
workers of Ohio as administered through the bureau. The committee may
create any subcommittees that the committee determines are necessary to assist
the committee in performing its duties. Any
subcommittee recommendations shall be submitted to the P & T
committee.

(4)
Providers must have experience with and
an understanding of the concepts of evidence based medicine as well as
contemporary best practices in appropriate prescribing, dispensing, and
monitoring of outpatient medications.

(5)
Providers must not be, or within the
previous twenty-four months have been, an employee of any pharmaceutical
manufacturer, pharmacy benefits manager, or any non-governmental firm or entity
administering state purchased health care program benefits or pharmaceutical
rebates.

(C)
The
appointing authority for members of the P&T committee shall be the
administrator or the administrator's designee(s), who shall appoint members of
the committee from the list of qualified providers developed and maintained by
the chief medical officer. Terms of membership for individual members of the
P&T committee shall be for one year. Individuals may be reappointed to
subsequent terms as determined by the administrator. Vacated terms shall be
filled in a like manner as for the full term appointments and shall be for the
remaining term of the vacated member.

(D)
The pharmacy program director of the
bureau shall be the chairperson of the P&T committee and shall provide
notice of meetings to the members and be responsible for the meeting agenda. In
addition, the pharmacy program director may be self-designated as an ad hoc
member of any subcommittees of the P&T committee; however, the pharmacy
program director shall be a voting member of the P&T committee and any
subcommittees only in the case of tie votes. The bureau chief medical officer
and bureau staff pharmacist may participate in discussions; however, they shall
not be voting members.

(E)
The
P&T committee shall develop and establish bylaws for the organization and
operations of the committee and subcommittees, subject to the requirements of
this rule and approval by the administrator.

(F)
The P&T committee
may make such recommendations as it
deems necessary to address any issue impacting the bureau related to
pharmacy or medication therapeutics. The committee
shall be responsible to respond to requests for action on any such issue
submitted by the bureau's administrator, chief of medical services, chief
medical officer or pharmacy director, including but not limited to:

(1)
Development, approval and annual review
of a formulary of approved medications.

(2)
Development, approval and annual review
of a list of non-covered, non-reimbursable medications.

(6)
Review of the bureau's
pharmacy providers' professional performance. The P&T committee shall
perform peer review according to generally accepted standards of pharmacy
practice and may recommend sanctions as well as termination of any pharmacy
provider determined to have consistently failed to meet those standards of
care.

(7)
Review of the
performance of the bureau's pharmacy benefit manager and conduct regarding its
management of prescription benefit services for the bureau.

(G)
The P&T committee shall
hold at least three meetings annually. The P&T committee and all
subcommittees shall keep written records of the agenda and minutes of each
meeting. The records of all committees shall remain in the custody of the chief
medical officer.

(H)
The P&T
committee shall submit an annual report of its activities and recommendations
to the administrator. In addition to inclusion in the annual report, all
recommendations from the P&T committee and subcommittees shall be submitted
to the chief medical officer in a timely fashion upon completion and approval
by the respective subcommittees and P & T committee.

(I)
Each member of the P&T committee and
its respective subcommittees may be paid such fees as
approved by the administrator
or the administrator's designee. The expenses
incurred by the P&T committee and its subcommittees and the fees of their
members shall be paid in the same manner as other administrative costs of the
bureau.